Running Head: FREQUENT USE OF EMERGENCY DEPARTMENT IN SAUDI PUBLIC 1 HOSPITAL: IMPLICATION FOR PRIMARY HEALTH CARE SERVICES FREQUENT USE OF EMERGENCY DEPARTMENT IN SAUDI PUBLIC HOSPITAL: IMPLICATION FOR PRIMARY HEALTH CARE SERVICES5 Frequent Use of Emergency Departments in Saudi Public Hospitals: Implications for Primary Health Care ServicesStudent’s Name:Institution Affiliation: Saudi Arabia faces a wide range of chronic conditions burden. Regardless of the increased numbers of the primary health care centers (PHCCs) as per the current evidence from the kingdom of Saudi Arabia, however limited. The current evidence asserts that utilization, as well as the access of PHCCs, which is crucial for the provision of intervention services, remains unequally distributed while the rural region is having poor access and utilization of the primary care services. There is limited evidence from Saudi Arabia, highlighting the barriers and facilitators influencing the access of and utilization of the “primary health care." There is frequent utilization of the emergency department in Saudi public hospitals. Frequent users are individuals who make numerous visits to the emergency department (ED) for a given period. However, there is a lack of census that defines the frequent users of ED services or care. Frequent users can account for a smaller portion of emergency department users but account for a large number of the visits. Such a population displays characteristics such as low socioeconomic status with mental as well as physical health issues (Alghanim, & Alomar, 2015). Frequent use of ED can result in overcrowding of the facilities leading to a low quality of care. Despite the presence of literature, there is no specific literature review that has been published yet concerning the statistical tools used for the examination of ED frequent users. Thus the goal of the research is to come up with a list of statistical tools applied in variable associated with the regular use or explaining the risk of becoming the frequent user. Also, the study will expound on factors affecting facilitation and utilization of PHCCs in both rural and the urban region of Riyadh province of the KSA For the research, Riyadh province will be the target site for the study. Based on the population density of both urban and rural area Of Riyadh will be identified, and the five regions with the highest and lowest “population density” will be picked. The two areas will be picked as they will meet the sample size. We will also perform a scoping review through the five-stage methodology framework. We searched sites such as Scopus, CINAHL, PubMed database using the search strategies redesigned by the expert or specialist, more so, out f of 4564 potential abstracts, we will pick about 112 journals or articles founded on the defined criteria and also presented in the content analysis. The method of data collection would be through survey and the use of public health surveillance in.

1. Running Head: FREQUENT USE OF EMERGENCY
DEPARTMENT IN SAUDI PUBLIC 1 HOSPITAL:
IMPLICATION FOR PRIMARY HEALTH CARE SERVICES
FREQUENT USE OF EMERGENCY DEPARTMENT IN SAUDI
PUBLIC HOSPITAL: IMPLICATION FOR PRIMARY HEALTH
CARE SERVICES5
Frequent Use of Emergency Departments in Saudi Public
Hospitals: Implications for Primary Health Care
ServicesStudent’s Name:Institution Affiliation:
Saudi Arabia faces a wide range of chronic conditions burden.
Regardless of the increased numbers of the primary health care
centers (PHCCs) as per the current evidence from the kingdom
of Saudi Arabia, however limited. The current evidence asserts
that utilization, as well as the access of PHCCs, which is
crucial for the provision of intervention services, remains
unequally distributed while the rural region is having poor
access and utilization of the primary care services. There is
limited evidence from Saudi Arabia, highlighting the barriers
and facilitators influencing the access of and utilization of the
“primary health care."
There is frequent utilization of the emergency department in
Saudi public hospitals. Frequent users are individuals who make
numerous visits to the emergency department (ED) for a given
period. However, there is a lack of census that defines the
frequent users of ED services or care. Frequent users can
account for a smaller portion of emergency department users but
account for a large number of the visits. Such a population
displays characteristics such as low socioeconomic status with

2. mental as well as physical health issues (Alghanim, & Alomar,
2015). Frequent use of ED can result in overcrowding of the
facilities leading to a low quality of care. Despite the presence
of literature, there is no specific literature review that has been
published yet concerning the statistical tools used for the
examination of ED frequent users. Thus the goal of the research
is to come up with a list of statistical tools applied in variable
associated with the regular use or explaining the risk of
becoming the frequent user. Also, the study will expound on
factors affecting facilitation and utilization of PHCCs in both
rural and the urban region of Riyadh province of the KSA
For the research, Riyadh province will be the target site for the
study. Based on the population density of both urban and rural
area Of Riyadh will be identified, and the five regions with the
highest and lowest “population density” will be picked. The two
areas will be picked as they will meet the sample size. We will
also perform a scoping review through the five-stage
methodology framework. We searched sites such as Scopus,
CINAHL, PubMed database using the search strategies
redesigned by the expert or specialist, more so, out f of 4564
potential abstracts, we will pick about 112 journals or articles
founded on the defined criteria and also presented in the content
analysis. The method of data collection would be through
survey and the use of public health surveillance information.
The independent variables would be factors like age, region,
income, and gender (Alfaqeeh et al. 2017). On the other hand,
independent variables would be income variables.
The number of PHCCs facilities increased by 2013; however,
there is still a shortage of services and resources such as the
number of beds (Alghanim, & Alomar, 2015). This has made
Riyadh province unable to cater for its people health-wise,
resulting to frequenting and crowding of PHCCs facilities and
hospitals. The government is expected to increase a total of 155
PHCCs through the country. Therefore the number of beds will
increase, and the frequent users will not cause commotion in the
hospitals (Alfaqeeh et al. 2017). Riyadh has one of the lowest

3. number of doctors compared to other provinces in Saudi Arabia.
This is due to the increase in the population in the province.
This may be a weak argument because provinces with the
highest population and rural areas like Baha, Qasim, and Najran
have a higher PHCCS as well as doctors (Yaya et al. 2017). This
information holds that in the provinces with secondary cities
and less socio-economically developed Are not typically
associated with shortages of shortages nor PHCCs (Alghanim, &
Alomar, 2015). Additionally, a large proportion of workers in
Saudis are non-Saudis, and this results in the highest number of
turnovers of the staff. Most of Saudis also “tend to migrate to
western countries to further their studies." After completion of
studies, they are retained in those countries. AS a result, the
Saudis healthcare workforce continues to be small.
The distance to the PCCs facilities is seen as the greatest barrier
to accessing of the services. Distance is seen as the barrier
despite of the other factors such as income, gender, and age for
the case of majority of the rural residents (Alghanim, &
Alomar, 2015). More so, the study will also explain how it is
less of a barrier for someone to live in an urban center.
Utilization of primary care services depends on the distance.
Service provision is another factors that influences access to
primary care services.
The low rate of patient satisfaction is experienced in Saudi
Arabia public hospitals. Factors such as poor patient care and
physical examination are bound to occur. The study will also
ascertain if there is the existence of primary healthcare services
all the time based on the participant’s response (Abuhammad, &
Dalky, 2019). We will also inquire if the patient had gotten the
test result on time or if the physician explained to them in a
way they can understand their medical status. More so, we will
find out if the patient worked into the PHCCs with an
appointment or not. In most cases, the patient dislikes the
system that lacks m booking of the appointment. Frequent users,

4. in this case, can cause commotions and overcrowding, which
leads to poor services in PHCCs. Other factors we will look at
opening time. Opening time of the hospital can act as a barrier
for access to primary care services. Some of the
recommendation that would be made out of this study the need
for recruiting more PHCCs physicians. The policymaker will
understand the holistic picture of health care status and deliver
a more efficient services, and then they will have to build more
PHCCs facilities.
References
Abuhammad, S., & Dalky, H. (2019). Ethical Implications of
Mental Health Stigma: Primary Health Care Providers’
Perspectives. Global Journal of Health Science, 11(12).
Alfaqeeh, G., Cook, E. J., Randhawa, G., & Ali, N. (2017).
Access and utilization of primary health care services
comparing urban and rural areas of Riyadh Providence,
Kingdom of Saudi Arabia. BMC health services research, 17(1),
106.
Alghanim, S. A., & Alomar, B. A. (2015). Frequent use of
emergency departments in Saudi public hospitals: implications
for primary health care services. Asia Pacific Journal of Public
Health, 27(2), NP2521-NP2530.
Yaya, S., Bishwajit, G., Ekholuenetale, M., Shah, V., Kadio, B.,
& Udenigwe, O. (2017). The urban-rural difference in
satisfaction with primary healthcare services in Ghana. BMC
health services research, 17(1), 776.
Running Head: PRIMARY HEALTH CARE SERVICE:
ANNOTATED BIBLIOGRAPHY 1
PRIMARY HEALTH CARE SERVICE: ANNOTATED
BIBLIOGRAPHY 4

5. Primary health care services: Annotated Bibliography
Student’s Name:
Institution Affiliation:
Statistical Tools to Analyses Frequent ED users
Chiu, Y., Racine-Hemming’s, F., Dufour, I., Vanasse, A.,
Chouinard, M. C., Bisson, M., & Hudon, C. (2019). Statistical
tools used for analyses of frequent users of the emergency
department: a scoping review. BMJ Open, 9(5), e027750.
The research paper asserts that frequent users represent a small
number of emergency department users however, these patients
account for a large number of facility visits compared to the
other population. Their utilization of ED is always conceded
suboptimal. It would have been better if they were identified
earlier and treated. This not only reduces crowding but also
improves the efficiency and quality of care. The paper looks at
how their characteristics can be identified and predict their
emergency department use. Adequate statistical tools are
required to carry out this function.
Utilization of Primary Care Centers
Alfaqeeh, G., Cook, E. J., Randhawa, G., & Ali, N. (2017).
Access and utilization of primary health care services
comparing urban and rural areas of Riyadh Providence,
Kingdom of Saudi Arabia. BMC health services research, 17(1),
106.

6. The research paper expounds more about access and utilization
of PHCs between the rural and urban populations in Saudi
Arabia. Furthermore, the study examines utilization and
experiences, in other areas of the kingdom of Saudi Arabia. The
paper also focuses on the barrier that results in inaccessibility
of primary healthcare services among the Saudis population.
Some of the barriers include shortages of the healthcare
workforce, distance from a rural area to the urban centers in
search of services and the presence of a few primary healthcare
centers resulting in congestions and overcrowding. The
research paper focuses on giving relevant data to policymakers
to provide efficient care services to the population of Saudi
Arabia.
Alghanim, S. A., & Alomar, B. A. (2015). Frequent use of
emergency departments in Saudi public hospitals: implications
for primary health care services. Asia Pacific Journal of Public
Health, 27(2), NP2521-NP2530.
The research paper focuses on determining reasons, factors as
well as prevalence related that the public emergency department
in Riyadh, Saudi Arabia. The study also uses questionnaires to
gather information from the adult patient concerning the
Accessibility, demographic characteristics among other primary
healthcare issues. According to the research paper, thirty
percent of the visitors were seen as the frequent users’ of the
emergency departments. A patient who was suffering from
chronic illness were more likely to frequent IN the emergency
department compared to other population. The study also asserts
that those patients who were referred to as frequent users made
numerous or multiple visits to the other healthcare facilities.
Thus policymakers should come up with healthcare decisions
that reduce the burden of frequenting emergency departments.
Trivedi, R. B., Post, E. P., Sun, H., Pomerantz, A., Saxon, A. J.,
Piette, J. D., ... & Nelson, K. (2015). Prevalence, comorbidity,
and prognosis of mental health among US veterans. American
journal of public health, 105(12), 2564-2569.
The research paper evaluate the association of mental diseases

7. with clinical outcome among the American veterans and
examine the impact of primary care-mental health integration.
Further the paper concludes that mental illness is related to the
poor outcomes however mental health treatment in primary care
is related to the lower risk of those outcomes. Besides
integration of mental health assessment management and
treatment of primary care setting disparities and fragmentation
continue to exist among specific regions and population.
Through VHA, PCMHI has been implemented to improve
detection and screening of mental illness.
Abuhammad, S., & Dalky, H. (2019). Ethical Implications of
Mental Health Stigma: Primary Health Care Providers’
Perspectives. Global Journal of Health Science, 11(12).
Stigma toward people suffering from mental health is not only
widespread in developing world but developed countries as
well. More so, veterans are expected by the society to remain
story and as such they will not look for treatment due to stigma
in the society. Stigma is not restricted to the specific population
but professional health care providers play a key role as well.
The research from developing countries is scarce as the purpose
of the research paper is to explore healthcare provider’s attitude
towards mental illness in primary care settings.
.
Written Capstone Research Project accounts for 50% of your
grade. Students are required to prepare their capstone research
utilizing appropriate research design procedures. The proposal
must include the following:
I. I. Title Page: The title page should contain the title of the
paper (no more than 15 words), the author's name, course name
and number, institutional affiliation, capstone advisor, and date.
Follow APA style for appropriate formatting.
I. II. Abstract: The abstract is a short summary of the paper

8. generally between 200 – 250 words in length. The abstract
should start with a brief theme sentence to orientate the reader
about the overall issue addressed in the article. This sentence
should grab the reader’s attention. The abstract should then
indicate the main aim or purpose of the study. Next, the
academic and/or practical importance of the study should be
explained. The methodology used in the study should also be
briefly described. The main findings of the study should be
HCA 598 (20/SP) 4
I. summarized. A statement of conclusions should indicate the
contribution made by the study in filling gaps in the literature.
Finally, the practical or managerial implications of the study’s
findings should be highlighted where appropriate.
I. III. Keywords: Include no more than 8 keywords that reflect
the discipline, sub-discipline, theme, research design and
context (industry and/or geographic location) of the study.
I. IV. Introduction: The introduction can be described as the
“executive summary” that provides readers a glimpse of what is
to come and must grab the reader’s attention. In other words,
the introduction must effectively “sell” the paper. This section
includes the following: (1) the broad theme or topic of the
study, (2) the academic and practical importance of the study,
(3) a summary of the available literature with the most
important previous studies that are relevant to the current
research cited, (4) an indication of the most important gaps,
inconsistencies and/or controversies in the literature that the
current study will address, (5) a clear indication of the the core
research problem/question to be addressed, the specific research
objective that will guide your research, the context in which the
study will be conducted, and the units of analysis of the study,
(6) an outline of the structure of the rest of the article.

9. The Introduction addresses the first criteria of the grading
rubric “Identification and Development of a
Solution
for a Domestic or Global Health Services Management or
Public Health Problem or Issue”
I. V. Methods: This section includes a detailed description of
the research methods that will be employed in your capstone
project. The following areas must be addressed: (1) population
and sample including the sample selection criteria, (2) study
design, (3) data sources, (4) methods of data collection, (5)
study variables (e.g., independent and dependent variables)
specified in operational terms, (6) analytic methods to be used
(make sure to identify the specific statistical procedures and
discuss their appropriateness). You should describe your
methodological choices in enough detail so that a reader who is
not involved in your study will know exactly what you did and
why.
I. VI. Literature review: The literature review represents the
core of the paper. This section includes (1) a brief discussion of
where the specific topic under consideration fits into the
“bigger picture” of the overall area under investigation, (2)
conceptual definitions of all the key concepts/constructs

10. included in the study, (3) a focused and synthesized discussion
of relevant previous research findings involving the
constructs/concepts relevant to your study, (4) a summary of
existing approaches to the measurement of the relevant
constructs, and (5) sufficient theoretical support for the
hypothesis to be tested/problem to be addressed.
The Literature Review addresses the rubric criteria one through
six “identify and utilize appropriate Healthcare Economics,
Health Policy, Marketing and Branding, and Financial Analysis
Approaches to Develop and Propose